This R21's FOA encourages the development of novel technologies that are aimed at sustaining independent living for people with chronic disabling conditions or reducing the burden on care providers. Our goal is to do both, to develop a new technology for a very high risk, high cost population - persons with cognitive impairment (PWCI) from Alzheimer's disease and their lay caregivers. The majority (64%) of primary family caregivers of PWCI report that daily dressing struggles are their most common source of caregiving distress yet interventions to substitute for caregivers are absent. In response we are proposing the Development of a Responsive Emotive Sensing System (DRESS) computer directed application innovatively using context- aware affective computing for PWCI. We will assess one's individual stress response through the use of skin conductance sensing (similar to what lie detectors use) that signal an arousal spike. Our wireless arm bracelet will have an imbedded signal sensor that transmits the emotional responsiveness of the participant to the DRESS system. DRESS will integrate the sensor data in real time using an existing GALLaG platform to offer words that coach and videos that demonstrate dressing tasks. The system will uniquely prompt and tailor to the PWCI's abilities and limitations with attention, initiation of action, and follow- through. DRESS will be designed to retrofit in one's ordinary home bureau. Three family caregiver focus groups have enthusiastically supported the need for dressing help and endorsed developing DRESS. In this pilot feasibility study, we will replicate the focus groups in AZ with predominantly Hispanic family caregivers to promote cultural sensitivity and to enable continual technical iterative improvements using a user centered design. We will develop DRESS specifications, custom software, implement and test the prototype to advance from the proof of concept stage to the alpha reliability stage, critical to complete before conducting intervention studies with human subjects. Project's High Impact: For PWCI they are provided a new form of affective responsive communication at a time when they are increasingly unable to accurately articulate and express their needs. Caregivers would be relieved of dressing struggles and gain "respite time", previously shown to reduce caregiver stress;and the field will be stimulated to develop more applications easily adapting to traumatic brain injury &stroke victims. The major public health impact would be the considerable monetary savings from prolonging PWCI functional independence in dressing (delaying institutionalization by 1 month saves 1.2 billion annually) and reducing lay caregiver morbidity from stress. Estimates indicate a tripling of PWCI by 2050 of up to 16 million patients.

Public Health Relevance

The majority (64%) of primary family caregivers of people with Alzheimer's disease report that daily dressing struggles are their most common source of caregiving distress, yet interventions to substitute for caregiver aided dressing are absent. In response, we are proposing the Development of a Responsive Emotive Sensing System (DRESS) application using novel context- aware computing that can detect a cognitively impaired person's emotional state through a small wearable wrist sensor that triggers the system to prompt when the person becomes stuck. A person's usual bureau dresser will be retrofitted with drawer sensors and an I Pad on top that offers visual cues and verbal prompting. In our preliminary study, caregivers enthusiastically supported the need for and acceptability of this approach. With continuing consumer input the system will be built and subjected to rigorous reliability and lab safety testing to ensure readiness for an in-home trial. The ultimate goal is t provide a new type of assistive technology tailored to persons with cognitive impairment that simultaneously prolongs their dressing abilities while reducing their caregivers'stress over dressing struggles. Increasing caregiver health and delaying nursing home placement for persons with dementia in the U.S., if only for one month, translates into an annual cost savings of 1.2 billion.